Survival Rate of Immediate Implants in Periodontally Compromised Patients: A Systematic Review

ABSTRACT

Background:

Immediate implant placement into a fresh extraction socket has been developed as a consistent treatment, allowing for a reduction in the duration of time necessary for prosthetic rehabilitation. The study will evaluate the clinical and radiologic outcomes of implants placed immediately for a 10-year follow-up period.

Aim:

The aim of this systematic review is to evaluate the durability of the immediate implant in periodontally compromised individual placement.

Methods:

Studies reporting clinical and radiologic implant outcomes from periodontally compromised individuals who were treated and followed periodontal and implant maintenance for ≥5 years were considered eligible for the review. Screening of the articles, data extraction, and quality assessment were conducted independently and in duplicate.

Results:

There were 99 papers, and of them, 55 were excluded after title/abstract assessment. The full texts of 28 potentially eligible publications were screened, but only seven studies met the inclusion criteria.

Conclusions:

The study confirms that immediate implant therapy is safe, effective, and predictable for successful osseointegration and long-term functioning in periodontally compromised individuals, with minimal differences in clinical and radiographic outcomes.

INTRODUCTION

Immediate placement is defined as the placement of an implant at the same time as the natural tooth is extracted into fresh extraction sockets. The technique was developed in response to patients’ growing demand for quicker treatment and a faster time to teeth. It helps to prevent and minimize the reduction of alveolar bone volume loss after tooth extraction. This concept was first introduced by Schulte and Heimke in 1976.[1] Therefore, immediate placement and provision offer a suitable solution for high patient satisfaction, when clinically indicated.[2,3]

Implant placement in sites with periapical pathology will result in implant survival rates comparable to those of implants placed immediately into sites without periapical pathology. Chronic periodontal disease has been linked to an increased risk of implant failure. Immediate implant applications do not allow the body tissues to complete the infection management.[4,5] Pathogenic bacteria were seen in the extraction sites even after extensive irrigation during implant surgery. Comprehensive curettage of granulation tissues and all soft tissue remnants in sockets is needed to reduce the inflammatory response. This clinical experience has led most clinicians to avoid immediate placement of endosseous dental implants in infected sites and to consider infection a contraindication to immediate implantation.[7,8] The presence of periodontal or endodontic infection compromises the success of immediate implant placement and whether it is recommended to treat the socket infection prior to immediate placement. The recent 10-year prospective research aims to evaluate the clinical and radiologic long-term outcomes of implants placed in fresh extraction sockets, with or without augmentation procedures [guided bone regeneration (GBR)] to support single crown restorations.[9]

Review question

The durability of the immediate implant in periodontally compromised individuals.

METHODS

Criteria for standardization and study type

The present analysis was performed according to the recommendations of the Cochrane Collaboration Guidelines for systematic reviews. It was ensured that standardization of the data inclusion/exclusion criteria and analysis, Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) criteria, and recently issued systematic review models were followed (Moher et al., 2009; Santiago et al., 2018).

Inclusion/Exclusion criteria

Inclusion criteria

• Human adults 18 years to 60 years in good general health.

• Presence of four bony walls of the alveolus.

• English publications in the dental literature.

• Studies reporting survival and success rates of immediate implants placed in extraction sockets that have periodontitis.

• Sites classified as having clinical/radiological signs of infection (periapical, periodontal lesion).

• Implant stability details.

Exclusion criteria

• Presence of fenestration of the residual bony wall.

• Patients with uncontrolled diabetes, coagulation disorder, alcohol or drug abuse, and chronic systematic disease.

• Animals studies.

• Unknown survival rates of immediate implants in the study.

Search strategy

The literature search was conducted from the following electronic bibliographic databases: PubMed/Medline, Cochrane Library (Central), Ovid, Web of Science, and Scopus. In addition, the search was performed at the Clinical Oral Investigations, Journal of Clinical Periodontology, and Journal of Periodontology. Only human clinical studies that have been published in English were screened. The publication period is not subject to any limitations.

Type of study to be included

Randomized controlled trials (RCTs), clinical trials, and systemic reviews (RCTs) on the survival rate of immediate implants in periodontal disease patients.

Strategy for data synthesis

Selected articles were analyzed and tabulated in the PICO format [Table 1]. The articles would be critically appraised using CONSORT and PRISMA guidelines. The results would be tabulated appropriately.

Table 1.

Pico tabulation

Author	Study design	Population	Intervention	Control	Results
Ronald E. Jung et al.[1]	Prospective, controlled clinical trial	Post-implant, patients with periapical pathologies.	Immediate implant placement in periapical pathology	Immediately placed implants in sockets with periapical pathology	After 5 years, the implant survival rate reached 100%, with a significant increase in keratinized mucosa width, but no significant differences in esthetic parameters or retrograde peri-implantitis were observed.
Ugo Covani et al.[2]	Prospective cohort Study	The clinical/radiographic measurements were repeated each year up to the 10th follow-up visit.	Immediate implant	Implants placed immediately, with the GBR procedure	The study revealed a 10-year cumulative success rate of 91.8% for implants, with stable clinical attachment levels and 82% marginal bone loss and 70% of sites showing acceptable outcomes.
Othman Shibly et al.[3]	RCT	Immediate loading or conventional loading after 3 months.	Immediate implant with periodontal disease	Immediate and conventional loading with periodontal disease	The study found a 95% implant survival rate for both groups, and the significant bone level increases in both groups. However, 65% of implant sites in group B were displaced coronally, compared to 15% in group A.
Bruno Ramos Chrcanovic et al.[4]	Systemic review	The selection criteria for studies included animal and human studies, excluding review and case reports, and implant placement into infection sites.		Periodontal or endodontic infections, immediate implant placement	Studies show high survival rates for endodontic and periodontal implants, but more randomized controlled trials and longer follow-ups are needed to confirm safety and benefits of antibiotic solution irrigation.
Vanessa Montoya-Salazar et al.[5]	Prospective study	NIL	Immediate implant with infected and non-infected sites.	Immediate implants placed in post-extraction-infected and non-infected sites.	The study found no significant differences in clinical and radiographic variables at 36 months, with a 94.44% 3-year survival rate for TG and 100% for CG.
Jie Chen, et al.[6]		Nil		Immediate loading versus early or conventional loading implants	The study analyzed 49 trials and found a lower survival rate in immediate loading dental implants compared to conventional loading, with no significant differences in other outcomes.
Chu-Tech Lee et al.[7]	Systemic review	The study analyzed publications, data, quality, implant survival rate, crestal bone level changes, soft tissue outcomes, complication, and procedure characteristics.		Immediate implant in sites with periapical lesion	The survival rate for implant placement in periapical lesions is 96.23%, with bone and gingival level changes comparable to those without pathology, with only 15.4% of complication rates reported.

Measures of effect

A minimum of 5-year follow-up.

Data extraction (selection and coding)

The latest information on each publication will be collected using standard protocols and reporting forms, including the first author, year of publication, study design, follow-up time, pathology type, implant failure rates, success, antibiotics used, treatment procedure, and marginal bone loss. Incomplete details will be contacted by the authors.

Risk of bias (quality) assessment

All selected articles will be assessed for BIAS. The JADAD scale will be used for assessment of BIAS. Depending upon the bias of selected papers, papers with higher levels of evidence will be included in the study.

RESULTS

Search results

The study found 99 electronic sources, selected 44 for duplicate removal, extracted 28 articles for qualitative analysis, and included 7 after assessing both abstracts and full texts. Referred to Figure 1.

Figure 1.

PRISMA flow chart showing identification and selection process of articles included

Overall survival rate

The study found that implant placement in extracted sockets with periodontitis did not significantly differ from those without pathologies in terms of survival rate. Over 1- and 5-year assessments showed a 95% success rate for individuals with known or treated periodontitis.[10] However, implant-supported fixed prostheses showed a significant reduced survival rate.[11,12]

Clinical gingival parameters

The one-stage technique has a 78% 10-year implant survival rate in periodontally compromised teeth, while the two-stage technique has a 97% survival rate. However, a deeper review suggests that other factors may influence the outcome, such as the hollow screw implants used in one-stage implants, which are untreatable once periimplantitis sets in.[8] The one-stage implants were inserted with a 25 N.cm torque and loaded with a detachable temporary partial denture after 2 weeks. A minimum insertion torque of 35 N.cm is now recommended for loading throughout the bone-healing process.[13]

Adjunctive therapies

The study found no significant changes in the first bone’s location between 1- and 5-year follow-ups of implant placement, consistent with earlier studies showing minimal bone loss within the first year.[14] Patients underwent a GBR procedure with minor difficulties during healing, but none failed when the horizontal defect size was greater than 2 mm or in dehiscence, the mucoperiosteal flap was moved, and the space between the buccal bone and implant surface was grafted in the socket.[15]

DISCUSSION

Immediate implant placement into an infected socket is controversial due to the lack of uniform standards for assessing the compromise rate associated with implants in contact with contaminated tissues. This article critically analyzes and reviews the literature on the association between the immediate placement of an implant into an infected socket and the implant survival rate, focusing on the case of infected lesions connected to significant bone loss. The study suggests that the degree of compromise can be gauged by examining the parts of the implant not supported by bone.

Immediate implant placement with periodontitis

The study found no significant differences in keratinized mucosa width, bone marginal levels, or clinical attached levels surrounding implanted teeth between study groups. The same findings were found for marginal bone levels and clinical attachment levels at the mesial surface. The findings suggest that early implantation of implants in diseased locations positively affects hard and soft tissue integration, highlighting the importance of primary stability in successful treatment.

Infection control

Infection can hinder healing and delay tissue degeneration. To achieve positive outcomes, bacterial contamination and plaque regulation are crucial. A proper clinical protocol allows for immediate implant placement and provision in infected sockets. Antibiotic therapy, local antisepsis, and prosthetic surgical procedure protocols were used, promoting esthetics and patient satisfaction without complications.

Immediate implant placement with regenerative approaches

Researchers have used guided tissue regeneration and guided bone regeneration procedures to compensate for deficient bone in infected extraction sockets. These procedures have a high success rate, high patient satisfaction, and preservation of hard and soft tissues. However, success depends on pre-operative planning and regeneration procedures. Immediate implant placement into extraction sockets can be successful with proper antiseptic protocols, but factors like primary stability, implant positioning, socket anatomy, soft tissue morphology, tooth position, implant system, and antiseptic protocol administration can affect success.

CONCLUSION

Immediate implant placement is a predictable treatment for compromised sites with acute periapical pathology. It supplies favorable esthetic, clinical, and radiographical outcomes over 10 years. Immediate placement improves mucogingival attachments. However, individual studies have limitations, and further long-term cohort studies and randomized clinical trials are needed to prove definitive guidelines and long-term observation periods. Effective supportive therapy and managing chronic illness are crucial for successful implant placement.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.